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How NOT to Make Your Rank List for Match Day 2021

January 22, 2021

Written by Aaron Lacy

Spoon Feed
When making hypothetical residency rank lists, applicants changed their preferences based on information that should not change true residency preferences, such as learning how competitively a program may have rated them.

Why does this matter?
The NRMP Match algorithm is set up to favor applicant preference for residency placement. If applicants are changing their rank lists based on factors that should not change their true preference order, they are putting themselves at risk for a suboptimal match. Both applicants and those who advise them must understand how the algorithm works and prioritize the right factors when making a rank list.

NRMP match.com
The National Residency Match Program (NRMP) match algorithm is created to promote optimal outcomes for applicants who submit true preference lists. However, students in the past have been shown to allow external information to affect their rank list. 3rd year medical students at a midwestern medical school were given hypothetical situations on things that could affect a rank list decision. Examples of things that should affect that decision included things such as “proximity to an ill family member” and “the only city a significant other could find a job in.” Things that should not affect a decision included things such as “learning they were ranked ‘low’ by that program.”

63% of responders reported that their “perceived competitiveness” would influence their rank list at least a “moderate amount.” 23% moved a program lower if they learned they were ranked ‘low’ by that program, while 6% moved a program higher if they learned they were ranked ‘at the top of the list.’ While we all enjoy being told that we are liked, and that sometimes can influence our decisions, it was interesting to see that participants responded similarly (k = 0.71) when the situation was presented asking what a colleague should do when similar factors were placed on them.  This shows that there is potentially misunderstanding of how the match algorithm works. If you are an applicant reading this, or someone who advises applicants, I urge you to focus on what really matters this match season. Focus on what is important to you and your family and where you want to go. Try to care a little less about what you ‘think’ a program ‘thinks’ about you. The match is set up to favor applicants, so rank accordingly.

Another Spoonful
Watch the NRMP video on how the match works, and how it aims to optimize applicant preference, not program preference.

Misunderstanding the Match: Do Students Create Rank Lists Based on True Preferences? West J Emerg Med. 2020 Dec 9;21(1):4-7. doi: 10.5811/westjem.2019.10.44308.

What are your thoughts?